A 6-year-old girl with new-onset type 1 diabetes is 6 hours into DKA treatment with isotonic fluids and an insulin infusion. Glucose has fallen from 520 to 300 mg/dL. She suddenly complains of severe headache, becomes drowsy, and her HR drops from 130 to 60/min while BP rises to 115/75 mmHg. Which is the most appropriate immediate treatment?
- A Stop insulin infusion and give 10 mL/kg normal saline bolus
- B Mannitol 0.5 to 1 g/kg IV over 10 to 15 minutes ✓
- C Immediate non-contrast CT head before any intervention
- D Furosemide 1 mg/kg IV
Correct answer: B. Mannitol 0.5 to 1 g/kg IV over 10 to 15 minutes
Explanation
Headache with a falling heart rate and rising blood pressure (Cushing response) during DKA therapy indicates cerebral edema, the leading cause of DKA-related death in children. Mannitol 0.5 to 1 g/kg over 10 to 15 minutes, or 3% hypertonic saline 2.5 to 5 mL/kg where mannitol is unavailable, must be given immediately at the bedside. Waiting for CT delays life-saving treatment. Furosemide worsens intravascular volume depletion and has no role here.
Reference: ISPAD Clinical Practice Consensus Guidelines / Nelson Textbook of Pediatrics, 2022 / 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.